January 24, 2023
2 min read
Goldberg JB, et al. Adult cardiac late breaker. Presented at: Annual Meeting of the Society of Thoracic Surgeons; January 21-23, 2023; San Diego.
disclosures: Goldberg does not report relevant financial disclosures. See the statement for the relevant financial information of all other authors.
There is some evidence that high-risk patients with pulmonary embolism may benefit from surgical treatment, according to a scientific statement from the American Heart Association.
“This statement demonstrates that modern surgical management strategies and mechanical circulatory support result in excellent survival (97%) even in the sickest patients, including those presenting with cardiac arrest and resuscitation,” Joshua B. Goldberg, MD, chairman of the statement writing group, an attending cardiothoracic surgeon, surgical director of the Westchester Transcatheter Heart Valve Program and director of Cardiac Surgery Outcomes Research at the Westchester Heart and Vascular Center in Valhalla, New York, said in a press release.
“Modern surgical strategies and mechanical circulatory support are drastically underused,” said Goldberg, who presented the statement at the annual meeting of the Society of Thoracic Surgeons. “It is the hope of the multidisciplinary group of authors that this scientific statement will raise awareness of the safety and effectiveness of modern surgical management and mechanical circulatory support in the treatment of the most unstable patients, thereby saving lives. In addition, we hope this statement will facilitate a better understanding of the disease process and effective treatments and encourage future research to improve the survival of patients with this common and deadly disease.”
The statement is endorsed by the STS and the American Association for Thoracic Surgery and its validity has been confirmed by the Society for Cardiovascular Angiography and Interventions.
Traditionally, surgical embolectomy and mechanical circulatory support have been considered rescue therapies for high-risk patients with PE, but modern surgical embolectomy and veno-arterial extracorporeal membrane oxygenation “demonstrate favorable safety and efficacy profiles when considering the baseline disease level of the populations in which they are used,” Goldberg and colleagues wrote in the scientific statement, published in Circulation. “Expanding the use of surgical embolectomy and mechanical circulatory support may provide additional survival benefit in a population where current treatment paradigms are still associated with extraordinarily high mortality.”
The writing group called for the inclusion of high-risk and fulminant patients in current and future PE registries, and for the redefinition of high-risk PE.
“To better stratify patients, compare treatment modalities and adjust outcomes, more accurate strata reflecting patients’ hemodynamic and clinical status are needed to separate the salvage/fulminant PE population from the high-risk population,” Goldberg and colleagues wrote.
In addition, the statement called for more education to encourage the use of surgical strategies earlier in the treatment of PE.